Feasibility of an Expanded Holding Protocol for the NICU

OBJECTIVE: To develop and evaluate the feasibility of an expanded holding protocol designed to increase opportunities for parent-infant physical contact in the NICU. DESIGN: Quality improvement feasibility study using a pre-post implementation design. SETTING: Level IV NICU at the Montreal Children's Hospital. PATIENTS/PARTICIPANTS: We applied the protocol to all infants admitted to the NICU. Outcome analyses included infants captured in a routinely collected data set submitted to the Montreal Regional Public Health Department. INTERVENTIONS: A multidisciplinary team developed a five-category holding protocol that expanded eligibility for skin-to-skin care and introduced additional methods of holding based on each infant's clinical status. The team introduced the protocol in April 2024 and supported its introduction through multidisciplinary, simulation-based education. MAIN OUTCOME MEASURES: Holding among newly eligible infants, proportion of infants with documented holding during admission, and timing of first documented holding. RESULTS: The expanded eligibility criteria made an additional 80 infants eligible for holding, and 26 (33%) of these infants had a documented holding episode. Documented holding increased from 71% (288/404) before introduction to 80% (365/454) after introduction (p = .002). The median day of first documented holding increased from 1 to 2 days of life (p < .001). CONCLUSION: The expanded holding protocol broadened eligibility for parent-infant physical contact and coincided with an increase in documented holding in the NICU. However, only one-third of newly eligible infants had a documented holding episode, which highlighted the need to address barriers to holding in addition to expanding eligibility.